AFP和PTA水平对ACLF患者预后的预测价值研究
发布时间：2018-11-16 16:28
【摘要】：背景慢加急性肝衰竭(ACLF)是肝衰竭中最常见的一类,它是依据肝脏组织病理学特征和病情发展速度的快慢而分类的。ACLF的预后普遍较差,肝脏移植是目前根治各种终末期肝病、挽救患者生命的有效手段。早期快速准确的预测ACLF患者的预后对临床治疗有重要的指导意义,从而帮助临床医生正确而快速的诊治该疾病。临床上有很多指标可以用来判断ACLF患者的预后,国内外关于单项血清甲胎蛋白(AFP)和单项血浆凝血酶原活动度(PTA)对于ACLF患者预后判断的意义均有大量报道,但两者联合报道却寥寥无几。目的评价血清AFP联合血浆PTA在ACLF患者中的应用价值。方法采用回顾性分析方法,选取自2013年1月至2016年1月南阳市中心医院收治的符合ACLF诊断标准的95例患者作为研究对象,根据预后将95例ACLF患者分为好转组(49例)和无效组(46例),通过Microsoft Excel 2010软件构建数据库,借助SPSS 17.0进行统计分析,通过卡方检验来分析定性资料数据,通过t检验来分析定量资料数据。同时,针对具备意义的因素,通过Logistic回归分析对其展开深入研究,将关系到慢加急性肝衰竭病人预后的独立危险因素筛选出来。比较好转组和无效组AFP、PTA的差异,以及两组患者AFP和PTA的不同水平间的比较。采用受试者工作特征曲线(ROC)下面积(AUC)评估AFP和PTA对ACLF患者预后的预测价值。结果1.经单因素分析筛选出对影响ACLF患者预后有影响意义的因素有年龄、凝血酶原时间(PT)、PTA、总胆红素(TBIL)、白蛋白(ALB)、AFP,其中P0.05。2.通过多因素Logistic回归分析对以上具备影响作用的指标加以分析,将对ACLF预后产生作用的独立危险因素筛选出来,仅PTA和AFP两项差异有统计学意义,其中P0.01。3.好转组与无效组AFP和PTA比较差异均有统计学意义(P0.01),好转组明显高于无效组。在AFP和PTA的不同水平上,好转组与无效组的发生率差异有统计学意义(P0.01)。研究对象受试者工作特征曲线(ROC)分析显示,采用AFP≥80.025μg/L联合PTA≥32.100%来预测ACLF的结局,曲线下面积(AUC)为0.989,敏感度为91.8%,特异度为100%。结论1.肝细胞坏死愈重,AFP水平愈低,AFP血清水平值与肝细胞坏死程度呈正相关,而且可以是独立的预测指标;肝细胞坏死愈重,PTA下降愈明显,PTA降低程度与肝细胞坏死的严重程度呈正相关,而且可以是独立的预测指标。2.血清AFP和血浆PTA是预测ACLF患者预后的重要指标,采用AFP联合PTA能更准确地预测ACLF患者的预后,且特异性更高。
[Abstract]:Background chronic and acute hepatic failure (ACLF) is the most common type of liver failure, which is classified according to the histopathological characteristics of liver and the speed of progression. The prognosis of ACLF is generally poor. Liver transplantation is an effective way to cure all kinds of end-stage liver diseases and save patients' lives. Early rapid and accurate prediction of the prognosis of ACLF patients has important guiding significance for clinical treatment, so as to help clinicians correct and rapid diagnosis and treatment of the disease. There are many clinical indicators to judge the prognosis of ACLF patients. There are a lot of reports on the significance of single serum alpha-fetoprotein (AFP) and plasma prothrombin activity (PTA) in judging the prognosis of ACLF patients at home and abroad. But there are few joint reports of the two. Objective to evaluate the value of serum AFP combined with plasma PTA in ACLF patients. Methods from January 2013 to January 2016, 95 patients admitted to Nanyang Central Hospital who met the diagnostic criteria of ACLF were selected as the study objects. According to the prognosis, 95 patients with ACLF were divided into two groups: improvement group (49 cases) and ineffective group (46 cases). The database was constructed by Microsoft Excel 2010 software and analyzed by SPSS 17.0. Qualitative data were analyzed by chi-square test. The quantitative data were analyzed by t-test. At the same time, the significant factors were studied by Logistic regression analysis, and the independent risk factors related to the prognosis of patients with chronic and acute hepatic failure were screened out. The difference of AFP,PTA between the improved group and the ineffective group, as well as the comparison of AFP and PTA levels between the two groups were compared. The area (AUC) under the operating characteristic curve (ROC) was used to evaluate the prognostic value of AFP and PTA in ACLF patients. Result 1. Age and prothrombin time of (PT), PTA, total bilirubin (TBIL), albumin (ALB), AFP, were selected by univariate analysis. The independent risk factors for the prognosis of ACLF were screened by multivariate Logistic regression analysis. Only PTA and AFP had statistical significance (P0.01.3). There were significant differences in AFP and PTA between the improved group and the ineffective group (P0.01), and the improvement group was significantly higher than the ineffective group. At the different levels of AFP and PTA, there was significant difference between the improvement group and the ineffective group (P0.01). (ROC) analysis showed that AFP 鈮，
本文编号：2336020
[Abstract]:Background chronic and acute hepatic failure (ACLF) is the most common type of liver failure, which is classified according to the histopathological characteristics of liver and the speed of progression. The prognosis of ACLF is generally poor. Liver transplantation is an effective way to cure all kinds of end-stage liver diseases and save patients' lives. Early rapid and accurate prediction of the prognosis of ACLF patients has important guiding significance for clinical treatment, so as to help clinicians correct and rapid diagnosis and treatment of the disease. There are many clinical indicators to judge the prognosis of ACLF patients. There are a lot of reports on the significance of single serum alpha-fetoprotein (AFP) and plasma prothrombin activity (PTA) in judging the prognosis of ACLF patients at home and abroad. But there are few joint reports of the two. Objective to evaluate the value of serum AFP combined with plasma PTA in ACLF patients. Methods from January 2013 to January 2016, 95 patients admitted to Nanyang Central Hospital who met the diagnostic criteria of ACLF were selected as the study objects. According to the prognosis, 95 patients with ACLF were divided into two groups: improvement group (49 cases) and ineffective group (46 cases). The database was constructed by Microsoft Excel 2010 software and analyzed by SPSS 17.0. Qualitative data were analyzed by chi-square test. The quantitative data were analyzed by t-test. At the same time, the significant factors were studied by Logistic regression analysis, and the independent risk factors related to the prognosis of patients with chronic and acute hepatic failure were screened out. The difference of AFP,PTA between the improved group and the ineffective group, as well as the comparison of AFP and PTA levels between the two groups were compared. The area (AUC) under the operating characteristic curve (ROC) was used to evaluate the prognostic value of AFP and PTA in ACLF patients. Result 1. Age and prothrombin time of (PT), PTA, total bilirubin (TBIL), albumin (ALB), AFP, were selected by univariate analysis. The independent risk factors for the prognosis of ACLF were screened by multivariate Logistic regression analysis. Only PTA and AFP had statistical significance (P0.01.3). There were significant differences in AFP and PTA between the improved group and the ineffective group (P0.01), and the improvement group was significantly higher than the ineffective group. At the different levels of AFP and PTA, there was significant difference between the improvement group and the ineffective group (P0.01). (ROC) analysis showed that AFP 鈮，
本文编号：2336020
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